From telegraph.co.uk
By Peter Schwarz
Diagnoses of the condition often come years too late, when much of the damage has already been done
Health systems are also paying too high a price. Global spending on diabetes now exceeds a staggering US$1 trillion, approximately 12 per cent of all health expenditure. A large share of this goes towards complications that present in cardiology wards, dialysis units, eye clinics, foot clinics, and operating theatres, many of which could have been prevented or delayed through earlier diagnosis and care.
As a clinician and researcher who has seen thousands of people with diabetes, I find this especially frustrating because the science behind diabetes care has never been stronger. Over the course of my career, I have seen new medicines and technologies – from continuous glucose monitors to the new GLP-1s – change what we can offer people with the disease. More than ever before, we have the tools to better support people to manage their condition, but these advances can only reach people living with diabetes once a diagnosis is made.
The evidence for acting early is clear. The landmark UK Prospective Diabetes Study found that managing type 2 diabetes from diagnosis reduced damage to the eyes and kidneys. Ten years after the trial ended, follow-up showed those benefits had lasted, with a 15 per cent lower risk of heart attack emerging over time. Early investment in diabetes prevention, detection and care can also pay back dividends for health systems. WHO estimates that in low- and lower-middle-income countries, every dollar invested in its recommended “best buys” for noncommunicable diseases, a package of interventions that includes diabetes management, could return up to US$7 by 2030.
But time is working against us. By 2050, an estimated 853 million adults aged 20-79 will be living with diabetes. In low- and middle-income countries, home to most people with undiagnosed diabetes, that pressure will come to bear on systems that are already stretched too thin.
So what needs to change? Closing the diagnosis gap means making testing and follow-up care accessible and affordable. Testing needs to move closer to where people already are, at routine health checks, pharmacies, community centres, and even supermarkets, supported by simple digital risk assessments. A diagnosis that leads nowhere adds costs and helps no-one, so every expansion of testing must result in more people receiving a timely diagnosis, appropriate support and sustained care.
Earlier testing also finds people at high risk before type 2 diabetes develops, when structured lifestyle programmes can help delay or prevent its onset. While more education will also help people to better understand their risk, it will be more effective when coupled with practical support to navigate checks and access lifestyle support.
As we prepare to mark World Diabetes Day on 14 November, IDF asks health leaders to fund national plans that connect risk assessment, prevention, testing and affordable treatment. A test takes a matter of minutes and can help protect many more years of good health. If you have ever thought “not me” but have known risk factors for type 2 diabetes, get tested and find out for sure.
https://www.telegraph.co.uk/global-health/science-and-disease/signs-diabetes/
I’ve spent three decades researching diabetes, a condition that costs more than a trillion dollars to treat every year, and I’ve stumbled on what I consider the most expensive and dangerous words in medicine: “not me.”
Perhaps we’re wired to believe things will turn out fine, and often that serves us well, but I regularly hear “not me” from people who carry several risk factors for type 2 diabetes – such as having a family history of diabetes or being overweight – but feel they are unlikely to actually go on to develop the condition. This is one reason why a diagnosis often comes years too late, after high blood glucose has silently begun to damage blood vessels, nerves and organs, and the cost of treating that damage has already started to climb.
New research released this week by the International Diabetes Federation examines how adults perceive their own risk for the disease. We surveyed 2,411 adults in six countries who had never been diagnosed with diabetes, all with known risk factors for type 2 diabetes. Most (84 per cent) said a check or test would be worthwhile, yet only 15 per cent thought they were likely to develop the condition. The findings show a critical gap between recognising the value of testing and recognising one’s own potential risk.
This gap has consequences. Type 2 diabetes often causes only mild or no symptoms and can go unnoticed for years, by which time serious complications may already have begun. Today, one in nine adults globally live with diabetes – that’s around 589 million people aged 20-79, and around 252 million of them do not know it. The time lost between when diabetes develops and a formal diagnosis is where the greatest costs accumulate for both people and health systems alike.
People are paying the price. Persistently high blood glucose over time damages the heart, kidneys, eyes, nerves and feet. The World Health Organization (WHO) attributes 11 per cent of cardiovascular deaths to high blood glucose, and up to 40 per cent of people living with diabetes are affected by chronic kidney disease. The toll on mental health is just as tangible. IDF research shows that 77 per cent of the people living with diabetes we surveyed reported anxiety, depression or another mental health condition linked to their diabetes. Stigma surrounding diabetes contributes to the mental health effects and, in some cases, leads people to stop seeking consistent care altogether.